AB0868 PREVALENCE AND RISK FOR BUNDLE BRANCH BLOCK, ATRIOVENTRICULAR BLOCK AND PACEMAKER IMPLANTATION IN SPONDYLOARTHRITIS. A SYSTEMATIC REVIEW OF THE LITERATURE
Authors: H. S. Park, A. Laiz, P. Díaz del Campo Fontecha, M. A. Martín Martínez, M. Guerra-Rodriguez, C. Alonso Martín, J. Sanchez-Vega, H. Corominas
Journal: Annals of the Rheumatic Diseases (2022)

Background Inflammation of the valve attachment site may produce tissue degeneration near the atrioventricular node, which may lead to electrical conduction disturbances, that is to say atrioventricular block (AVB) and bundle branch block (BBB). Objectives To evaluate the evidence regarding the prevalence and risk of BB, AVB and pacemaker implantation (PMI) in patients with spondyloarthritis (SpA) compared to a control group without SpA. Methods A systematic review of the literature was performed using Pubmed (Medline), EMBASE (Elsevier) and Cochrane Library (Wiley) databases until December 2021. The risk for AVB, BBB and PMI were analyzed. Cohort, case control and cross-sectional studies in patients ≥18 years meeting the classification criteria for SpA were included. The Odds ratio (OR), risk ratio (RR) or Hazard ratio (HR) were considered as outcomes. Data was synthesized in a previously defined extraction form. The risk of bias was assessed by the Newcastle-Ottawa Scale. Results In total, eight out of 374 studies were included. As for low grade AVB and BBB, only indirect results comparing prevalences from low to medium quality studies were found. According to population based registries, the sex and age adjusted HR of AVB was 2.3 (95% CI 1.6 - 3.3) in ankylosing spondylitis, 2.9 (95% CI 1.8 - 4.7) in undifferentiated spondyloarthritis and 1.5 (95% CI 1.1 a 1.9) in psoriatic arthritis. The RR for PMI was 1.3 (95% CI 1.16 - 1.46) for groups aged between 65-69 years, 1.33 (95% CI 1.22 - 1.44) for 70-75 years, 1.24 (95% CI 1.55 - 1.33) for 75-79 years and 1.11 (95% CI 1.06 - 1.17) for groups older than 80 years. Author Study design Population Sample number Test Outcomes Adjustment Baniaamam 2021[6] Cross sectional AS and osteoarthritis between 50-75 years 267 ECG Prevalence of AVB, BBB and PMI Controls matched for age, sex and smoking status Bengtsson 2017[12] Cohort AS, uSpA, PsA, GPfrom the Swedish national registry 294136 ICD-10 Prevalence, Incidence, HR, for AVB and PMI compared to GP Age, sex Dik 2010[9] Cross sectional AS 131 ECG Prevalence of AVB and BBB Association of PR interval with AS disease related variables Age, sex, disease duration Feld 2008[10] Case control PsA compared to non psoriatic nor arthritic patients 184 ECG Prevalence of AVB, BBB Correlation of PR interval with AS disease related variables None Fu 2016[8] Cross sectional AS between 18-50y without cardiac disease 122 ECG Prevalence of AVB, BBB AS without kyphosis None Goulenok 2010[13] Cross sectional SpA, RA and control group without known CV disease 288 ECG Prevalence AVB, BB None Ward 2018[7] Cohort AS from Medicare database older than 65 42,327 ICD-9 Prevalence, incidence, OR of PMI Age, sex, race Yildrir 1999[11] Case control AS 88 Holter and ECG Prevalence of AVB None Conclusion The differences of prevalence in AVB and BBB were similar in SpA and control groups even though studies lacked the power. According to population registries there was an two fold-increased risk of high grade AVB in SpA patients. RR for PMI was higher in younger age groups. Disclosure of Interests Hye Sang Park: None declared, Ana Laiz Speakers bureau: A.L. has received speaker fees/honoraria from Abbvie, Lilly, Novartis, Pfizer and UCB, Petra Díaz del Campo Fontecha: None declared, Mª Auxiliadora Martín Martínez: None declared, Mercedes Guerra-Rodriguez: None declared, Concepción Alonso Martín: None declared, Jesus Sanchez-Vega: None declared, Hector Corominas Speakers bureau: H.C. has received speaker fees/honoraria from BMS, Gebro, MSD, Lilly, Novartis, Pfizer, Roche, Sanofi, and UCB, Consultant of: H.C. has participated in consulting for Abbvie, Amgen, Biogen, Celgene, Gilead, Kern, Pfizer and Sanofi.